Document Detail


Is endoscopic papillectomy safe for ampullary adenomas with high-grade dysplasia?
MedLine Citation:
PMID:  19568817     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study was designed to provide safe management guidelines for ampullary adenoma by analysis of clinicopathological features. BACKGROUND: The treatment of ampullary cancer has been established; however, the indications for treatment of ampullary adenoma remain controversial. METHODS: Between July 1997 and July 2008, a total of 33 patients were diagnosed with ampullary adenoma prior to procedures: 20 endoscopic papillectomies (ESP), 5 transduodenal resections (TDR), and 8 pancreatoduodenectomies (PD). RESULTS: The false-negative rate of biopsy for cancer was 27.5% (8/29). Coexistence of cancer in patients with pre-high-grade dysplasia (HGD) was 50.0% (5/10), whereas it was 15.7% in pre-low-grade dysplasia (LGD). In addition, the rate of recurrence was 80% (8/10) in patients with pre-HGD. The size of tumor by final pathology was 1.27 +/- 0.89 cm in LGD, 1.81 +/- 0.99 cm in HGD, and 1.98 +/- 1.08 cm in cancer group. There was a significant correlation between size of tumor and final pathology (P = 0.036). According to receiver operating characteristic (ROC) curve, criterion to predict HGD/cancer was tumor size larger than 1.5 cm; sensitivity and specificity were 55.6% and 80.0%, respectively, and likelihood ratio was 2.778. However, size of tumor was not associated with preprocedural pathology. CONCLUSIONS: Ampullary adenoma with preprocedural HGD was highly associated with coexistence of cancer and recurrence. Moreover, most of large tumors were treated by surgical procedures and proved to be cancer. Therefore, we suggest that ampullary adenoma with preprocedural HGD or more than 1.5 cm should not be managed with endoscopic papillectomy due to high associated rates of recurrence.
Authors:
Ji Hun Kim; Jin Hong Kim; Jae Ho Han; Byung Moo Yoo; Myung Wook Kim; Wook Hwan Kim
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Publication Detail:
Type:  Journal Article     Date:  2009-07-01
Journal Detail:
Title:  Annals of surgical oncology     Volume:  16     ISSN:  1534-4681     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-14     Completed Date:  2009-11-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2547-54     Citation Subset:  IM    
Affiliation:
Departments of Surgery, School of Medicine, Ajou University, Suwon, Korea.
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MeSH Terms
Descriptor/Qualifier:
Adenoma / pathology,  surgery*
Aged
Ampulla of Vater / pathology,  surgery*
Common Bile Duct Neoplasms / pathology,  surgery*
Endoscopy, Gastrointestinal*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Recurrence, Local / pathology,  surgery
Neoplasm Staging
Pancreaticoduodenectomy
Prognosis
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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